Eye
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Randomized Controlled Trial Comparative Study Clinical Trial
Warming lignocaine reduces the pain of injection during local anaesthetic eyelid surgery.
The injection of local anaesthetic solutions is frequently a painful and unpleasant experience for patients. A double-masked randomised controlled trial was performed to study the potential benefit of warming lignocaine during local anaesthetic minor surgical procedures on the eyelids. The pain of subcutaneous injection of 1.5 ml of 2% lignocaine at room temperature (cold) and body temperature (warm) was compared in 60 patients during the surgical incision of solitary meibomian cysts of one eyelid. ⋯ The median pain score for the group receiving cold anaesthetic (19.5) was found to be greater than that for the warm group (10.0; p = 0.02). In conclusion, the simple process of warming lignocaine to 37 degrees C was found to reduce the pain associated with its injection significantly. It is recommended that this technique be more widely adopted in order to minimise patients' discomfort.
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Randomized Controlled Trial Comparative Study Clinical Trial
Peribulbar anaesthesia for cataract surgery: prilocaine versus lignocaine and bupivacaine.
Prilocaine has recently been introduced for use in ocular local anaesthesia. A prospective randomised double-masked study was undertaken to assess the efficacy of prilocaine 2% plain versus a mixture of lignocaine 1% and bupivacaine 0.5%, each with hyaluronidase. ⋯ Prilocaine is a useful alternative anaesthetic agent for eye surgery that has low toxicity and is effective without adrenaline.
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Randomized Controlled Trial Comparative Study Clinical Trial
Randomised trial of topical versus sub-Tenon's local anaesthesia for small-incision cataract surgery.
Fifty unselected patients undergoing routine cataract surgery were randomised to receive either topical or sub-Tenon's local anaesthesia with 2% prilocaine administered by a blunt cannula. Visual analogue scales were used to assess pain during administration of sub-Tenon's anaesthetic and pain during surgery, and any complications were noted. ⋯ Both techniques compared well with other studies assessing periorbital or retro-orbital injections, and both have significant safety advantages which are discussed in the context of the joint Royal Colleges report on ophthalmic anaesthesia. It is suggested that a combination of one or other technique could safely cover all requirements for intraocular surgery under local anaesthesia.
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Giant cell (temporal) arteritis is a systemic vasculitis of the elderly. Facial swelling is a rare manifestation of the arteritic process. Delay in recognition of the condition can result in profound loss of vision. ⋯ Both arteritic AION and facial swelling responded to high-dose steroid treatment. Facial swelling in giant cell (temporal) arteritis could be an indicator of risk of AION. Intravenous steroid treatment can lead to salvation of useful vision.
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Life-threatening systemic complications during ophthalmic surgery under local anaesthesia are rare. However, respiratory and cardiovascular complications can cause significant morbidity and mortality. ⋯ Due to ease of handling and interpretation, the equipment can be used effectively for peri-operative monitoring without any specialist training. All patients should be carefully monitored during local anaesthesia with pulse oximetry and cardiac monitors.